Introduction
Optimal pump positioning is important for adequate ventricular unloading and post-surgical outcomes for patients undergoing ventricular assist device (VAD) implantation.1 Furthermore, the geometry of the ventricles and the position of the ventricular septum in patients with congenitally corrected transposition of the great arteries (ccTGA) are quite different from those in a structurally normal heart, posing a unique technical challenge in systemic right ventricular assist device (RVAD) implantation. Herein we present a case of a 16-year-old male with ccTGA, whose systemic RVAD (HeartMate IIIĀ® or HM3) implantation was complicated with the creation of an iatrogenic ventricular septal defect (VSD), with special focus on surgical and medical managements for severe systemic right ventricle (RV) dysfunction and torrential systemic tricuspid insufficiency. Consent was granted by the subject patient to publish the case report.